Pharmacies are the most accessible service providers in healthcare. The proposal does not expand the pharmacy network—which is already one of our biggest health resources—but rather broadens the scope of assistance that pharmacists with medical education can offer to patients, how these services are reflected in the health information system, and how they are reimbursed. With this amendment, pharmacists will have the opportunity to contribute to health promotion and disease prevention.
Expectations for quality pharmacy services increasingly involve comprehensive counseling and disease prevention, not merely the dispensing of medications. The share of clinical pharmacy in pharmacist training has increased, and using this expertise in daily work is highly necessary. In Estonia, there is a growing number of people who use multiple medications simultaneously—every day, we see medication regimens in pharmacies where one person takes 10–15 medications in a single day. Unfortunately, these medications are often prescribed by different doctors, and sometimes a recommendation remains part of the regimen even after the illness it was intended to treat has passed. Modern pharmacy services around the world offer medication usage assessment services, where a pharmacist reviews a person’s medication plan and makes suggestions to the doctor for necessary changes, thereby helping to avoid overuse, underuse, and side effects of medications.
In addition to medication assessments, pharmacists in many countries also provide first-time medication use and chronic disease medication counseling. In some countries, to improve access to medications, pharmacists are also allowed to prescribe medications or extend existing prescriptions.
Pharmacists, as medical professionals with higher education, can support patients in health promotion—for example, in quitting smoking—by using replacement preparations such as nicotine gum, patches, or sprays. International studies indicate that counseling and support are often necessary beyond just replacement therapies, with 4–6 sessions recommended. Many people trying to quit smoking today buy replacement medications from pharmacies, but the state only funds counseling services through doctors and nurses.
Smoking rates in Estonia are fortunately declining, but e-cigarette use is rising rapidly, especially among younger people. A walk through schools reveals how many students have fallen into the trap of e-cigarettes. Pharmacists’ assistance should be welcomed. It's also puzzling why, in a society increasingly aware of environmental issues, single-use e-cigarettes—polluting with plastic and electronics—are still permitted.
The state aims to involve pharmacies more extensively in screening programs. Research indicates that screenings are effective when at least 70 percent of the target group participates. Before 2021, participation in cervical cancer screenings in Estonia was below 50 percent. Every year, about 160 women are diagnosed with this cancer, and unfortunately, around 60 succumb to it. In recent years, since pharmacies started offering home test kits, participation rates have significantly increased—by nearly a fifth, reaching 64 percent over three years. Pharmacists can contribute even more in this area. Screening participation has grown most in regions where pharmacies distributed home tests as part of pilot projects, such as in Ida-Viru and Võru counties. The number of home test kits distributed by pharmacies is growing rapidly. We are on the right track!
We must achieve higher vaccination coverage
The legislative amendment will give pharmacists the right to vaccinate patients against the flu, tick-borne encephalitis, COVID-19, and, I believe, more diseases in the future. If you go to a pharmacy for a vaccination today, you will notice that the service is provided by a nurse, not a pharmacist. There is no credible justification for this, and over 40 developed countries have already recognized this. Statistics support this change—there has not been a single case where vaccination in a pharmacy was more dangerous than in a vaccination center or general practitioner’s office. None. But the need is significant; for example, in Estonia, 1,700 people are hospitalized each year with complications from the flu. This is twice the population of the entire island of Kihnu. Unfortunately, about a hundred of these patients die every year.
We must achieve higher vaccination coverage, which, after COVID-19, has further declined due to misconceptions and prejudices. The World Health Organization (WHO) recommends that at least 95 percent of children should be vaccinated. In Estonia, we have dropped below 70 percent in this regard—a very real and serious threat to future generations. Vaccination is a fundamental decision, and while pharmacies do not plan to administer pediatric vaccines in the future, we can help raise awareness about the importance of vaccinations to prevent diseases. Unvaccinated children can, in turn, contribute to the wider spread of diseases.
Adult booster vaccinations for various diseases can also be administered in pharmacies, such as for diphtheria, tetanus, and pertussis. Pharmacies, being the most accessible healthcare providers, can do a great deal of work in this area.
Doctors and pharmacists should form a coalition
If anything about this important shift in state policy is surprising, it’s the somewhat hesitant attitude of general practitioners. Looking at the future demographics of our population, it is clear that we are aging, and thus we need more support. Doctors alone cannot provide this; our healthcare system needs a broad coalition that supports each other. Claims about service duplication simply don’t hold in a situation where it can sometimes take a long time to get an appointment with a family doctor. Sound familiar? Pharmacists are an inevitable part of this system. Their knowledge and skills could be utilized much more effectively if digital solutions allowed doctors and pharmacists to exchange the necessary information for dispensing medications. Believe it or not, such an option is currently lacking in our e-state.
Our patients’ adherence to prescribed treatments—how well they follow the treatment plans set by doctors—is poor. This is a significant waste but, more importantly, it’s dangerous for people’s health and burdens our healthcare system. By providing pharmacists with access and the ability to exchange information in digital environments with other healthcare professionals, we can improve communication, ensuring better services for patients. This alone would save millions of euros annually for our healthcare system, not to mention saving lives. The state has made substantial investments in developing various decision-support tools, but pharmacists do not have access to them, meaning people may receive slightly different advice from doctors and pharmacists.
As a citizen reviewing the national budget framework, I am confident that Estonia can achieve much better results in healthcare by supporting broad collaboration. As the leader of Estonia’s largest pharmacist association, I can confirm that we are ready to assist patients.
Published in Postimees on October 11, 2024